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About a year ago, Danny Wylde wound up in the emergency room with a large needle sticking out of his erect penis. That wasn’t the problem; it was the treatment.

After taking 80 milligrams of the erectile dysfunction drug Cialis—four times the recommended daily maximum—the 28-year-old porn performer had developed the erection to end all other erections, or rather, the erection that justwould not end. By the time he took himself to the emergency room, this pharmaceutically-assisted boner had been raging for more than 12 hours straight. If it continued, he risked doing permanent damage to his penile tissue, even losing his career-defining member entirely. The doctors had only one solution: Using a syringe to drain the blood from his penis.

Performing in porn is like being a professional athlete, an occupation now widely linked with drug abuse

Over his eight years in the adult industry, Wylde had routinely used Cialis and occasionally dabbled in the injectible erectile-dysfunction drug Bimix, which is shot directly into the penis. This was the third time it had landed him in the hospital—but this time was different. The ER doctor told him that unless he stopped abusing erectile dysfunction drugs, he might lose the ability to get an erection. “That's when I kind of freaked out,” said Wylde. “I'm not gonna give [sex] up at age 28 so that I can do porn for a couple more years.” He retired from performing the very next day.

It was a devastating decision. “That had been my career for eight years. This was my job, my means of income, my identity—all of that just fell apart overnight,” he says “It was earth-shattering.” You might wonder: Why not continue in porn, only without the pharmaceutical help? Impossible, says Wylde. “Prior to taking the drugs, I failed scenes,” he said. “I would not be able to do it.”

(Studies have shown that regular usage of Cialis and Viagra by young men in the general populace may lead to psychological dependency on EDs along with the thwarting of normal sexual functionality, which itself increases dependency. ED drug usage in the porn industry far exceeds the public average among young men.)

Wylde’s story might sound extreme, but the off-label use of these prescription drugs is a norm in the adult industry. “I’m aware of two male performers who I actually believe don't take them,” said Wylde. “Everyone else I'm pretty sure does. I would say most people take them every scene.” Sometimes they’re supplied on set by producers or directors. In fact, in 2012 a stagehand sued Adult Entertainment Broadcast Network, alleging that he was forced to inject Trimix into performers’ penises, despite his objection to administering the drugs to men without prescriptions.

Several of the adult industry insiders that I spoke with said ED drugs, especially injectables, are more out in the open on gay porn shoots, partly because of the constant flow of inexperienced male talent and so-called “gay-for-pay” performers in need of assistance becoming aroused. “On straight porn sets, guys try to hide it a little more because of machismo, or they think some girls are uncomfortable with seeing it and knowing a guy has a medicated erection,” says Wylde.

At the start of his career, before he ever touched ED drugs, Wylde tried to perform without a little help. “I was unable to get an erection for more than, like, 30 seconds at a time,” he said. “So we had to cancel the scene.” Then he was introduced to a doctor who gave him samples of Viagra, Cialis and Levitra. I spoke with another male performer, who wished to remain anonymous, who told me about a doctor in so-called Porn Valley who is known for providing ED prescriptions to adult performers. (Unsurprisingly, this doctor did not respond to requests for comment.) Of course, counterfeit, illegal versions of these drugs are available online without a prescription.

Despite the prevalence of ED drugs in the industry, few performers are willing to talk openly about it. When I asked a popular male performer who asked to not be identified whether he’d ever seen other guys on-set taking these drugs, he said, “Male performers are not gonna take ED stuff around other male performers, you should know that. What guy wants to admit that he isn't a naturally sexual stallion?” As for his own regimen, he says, “I generally take half a Viagra if I have two scenes in a day as a little booster. The phrase is, ‘It can't hurt you it can only help you.’”

Well, except that it sometimes does hurt when abused. A few years ago, award-winning porn director Axel Braun had to send a popular male performer to the hospital. They had wrapped a sex scene a few hours earlier and were waiting to shoot some dialogue when Braun noticed the star still had an erection. “He was pasty white and his 12-inch penis was bursting through his pants.” The performer’s erection persisted for six hours. It turned out he had used the injectable Caverject and ended up having the blood drained from his penis at the hospital. “There are only a handful of guys in the whole industry who don't use ED drugs and still can perform at a high level,” says Braun.

What happened to both Braun’s performer and Wylde is called priapism. Dr. Richard Lee, a urologist at the Iris Cantor Men's Health Center, says, “Imagine a tourniquet around your finger. If you’ve got a tourniquet around your finger for a long time, you’re gonna cause damage to the tissues of the finger. So if you’ve got repeated episodes of priapism, then, yeah, you’re gonna have an issue.” But he says that the general class of erectile dysfunction medications is “relatively safe” and that if used properly, “You should be able to use them indefinitely."

But male porn stars’ use of these drugs is by definition not-as-directed, because most don’t have erectile dysfunction to begin with. What’s more, the pressures of professional sex can be conducive to overuse. A whole lot is riding on their erections, as porn director Joanna Angel points out. “Literally an entire 50K-worth of production could all be ruined if your penis can't get hard,” she says. “If they can't perform, it's not just going to ruin their day, it's going to ruin everyone's day on set.” Not only do male performers have to be able to get an erection, they sometimes have to maintain it, or summon it off and on, over the course of three hours, she says.

Wylde says there’s nothing natural about what’s required of male performers. “If your sole job is to have an erection and get it done quickly so that everyone can get home on time,” he said, “you need to be a machine” —or a medicated human. In that sense, performing in porn is like being a professional athlete, an occupation now widely linked with drug abuse. “Look at UFC, football, basketball. Look at weight lifting,” he says. “Nobody is natural. All of that is a result of steroids and performance enhancing drugs.” The truth, he says, is that without the help of ED drugs “you're just going to be horrible at it—unless you're a mutant.”

Beyond just the endurance required, there is the occasional unsexiness of the sex. “I just don't think most men have an experience where basically you meet somebody and you're supposed to engage in some sexual encounter with them without perhaps having any attraction to that person and perhaps without that person having any interest in you,” he says.

It’s uncommon to become physically addicted to ED drugs, says Dr. Lee, but Wylde is convinced that he was at least psychologically dependent. His push-pull relationship to the drugs certainly relates to that of addiction. He used Bimix for a couple months and then ended up in the hospital the first time, which led him to stop for several years. But then he says, “I used it on several occasions during times where I just felt stressed out in my life and was having a hard time doing my job,” he said. “I went back to it and then I would have these really lengthy erections after work and it scared me and I would try to stop and would, usually for months to a year, and then at the end, the last year or two I was basically just using Cialis, but more frequently and using more of them per scene.”

Now, a year after that fateful hospital trip, Wylde is in some ways glad it happened, because it pushed him into editing and production work. It also revitalized his sex life. “I luckily had a partner who stayed with me through that process and kind of rekindled my sexual experience outside of using those drugs,” he says. “Now things are great. All is in working order, which is nice.” Despite his experience, Wylde has no hard feelings toward the industry, which he now works in behind the scenes. “People have asked me if I think it's a problem, am I against using ED drugs? My answer is not really. The reason is, I don't think that most people should get into porn to be honest. It’s not what people think.”